Perioperative medicine & outcomes
Impact of sex on the association between neutrophil percentage-to-albumin ratio and mortality in perioperative patients with chronic kidney disease: a retrospective analysis of the INSPIRE database
Authors' conclusion
Our findings indicate that an elevated NPAR is significantly associated with higher in-hospital and 30-day mortality in female CKD patients who have undergone surgery but this association is not significant in males.
Study context
- Population
- Surgical patients with chronic kidney disease (CKD), INSPIRE database, 2011–2020
- Participants
- 2,474 patients
- Exposure
- Neutrophil percentage-to-albumin ratio (NPAR) tertiles and NPAR per unit, by sex
- Outcome
- In-hospital mortality and 30-day mortality
Methodological detailsINSPIRE database, sex-stratified analysis
- INSPIRE database
- Sex-stratified analysis
Main finding
As reported in the abstract
In-hospital mortality, females
Hazard ratio (95% CI)P value
NPAR (per unit)
2.56(1.73–3.78)
P < 0.001T3 vs T1
2.93(1.48–5.80)
P = 0.002Observational data: associations, not effects.
Further findings
30-day mortality, females (subgroup)
| HR (95% CI) | P value | ||
|---|---|---|---|
| NPAR continuousModel 4 | 4.13 (2.61–6.52) | P < 0.001 | |
| 0.10.31310Hazard ratio (log scale) |
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| 30-day mortality, females (subgroup) · 30 daysT3 vs T1 · Model 4 | 10.87 (4.46–26.51) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
- 30-day mortality, females (subgroup): significant sex-specific interactions (p < 0.05 for trend differences)
30-day mortality, females (subgroup)
- No significant association in males even after full adjustment
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Impact of sex on the association between neutrophil percentage-to-albumin ratio and mortality in perioperative patients with chronic kidney disease: a retrospective analysis of the INSPIRE database. Perioper Med (Lond). Published 16 March 2026. doi:10.
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